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Search Results: 1 - 10 of 154241 matches for " Matthew F Chersich "
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Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry
Courtenay Sprague, Matthew F Chersich, Vivian Black
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-10
Abstract: In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation). By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate.A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing accountability systems; improving HIV services in labour wards; ensuring quality HIV and infant feeding counselling; and improved monitoring for performance management using robust systems for data collection and utilisation.In 2002, a national programme to prevent mother-to-child transmission of HIV (PMTCT) was established in South Africa, followed by an antiretroviral treatment (ART) initiative in 2004. To enhance ART access for pregnant women and address high mortality among women and children, eligibility criteria for ART initiation were revised in April 2010 to include all women with a CD4 cell count below 350 cells/mm3 [1,2]. This marked a notable departure from previous ART criteria of an AIDS-defining condition or a CD4 count below 200 cells/mm3 [3,4], and is consistent with WHO guid
Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa
Matthew F Chersich, Helen V Rees, Fiona Scorgie, Greg Martin
Globalization and Health , 2009, DOI: 10.1186/1744-8603-5-16
Abstract: Globally, HIV and other sexually-transmitted infections (STI) account for 6.3% of the burden of disease and alcohol for 4%, similar to that caused by tobacco (4.1%) and high blood pressure (4.4%) [1]. In some sub-Saharan countries, such as South Africa, for example, the burden attributable to these conditions is even greater - HIV and other STI constitute about a third of disease and alcohol an estimated 7.9% [2]. Overall, much of sub-Saharan Africa carries a massive burden of HIV and of alcohol disease, and these pandemics are inextricably linked. The conditions share many common determinants and together exacerbate the underlying socio-economic inequalities in this region. As we discuss in this article, alcohol disease and HIV have an especially intimate link: alcohol has independent effects on decision-making concerning sex, and on skills for negotiating condoms and their correct use. Thus far global initiatives to prevent HIV and other sexually transmitted infections (STI) have largely ignored the potential mediatory role of alcohol in unsafe sex (for example, note that the list of WHO HIV prevention priorities does not mention alcohol) [3].Alcohol use results in a considerable range of diseases, the occurrence of which is contingent upon three factors: lifetime cumulative volume consumed; patterns of drinking; and drinking contexts [4,5]. Overall lifetime volume of alcohol is linked to chronic social problems (such as unemployment) and to chronic diseases such as alcoholic liver cirrhosis. By contrast, pattern of drinking (amount per drinking episode), in particular frequent episodes of intoxication, is a powerful mediator of acute problems such as accidents, interpersonal violence and high-risk sexual behaviour [5,6]. Context of alcohol use is also a critical determinant of its consequences, as opportunities for sexual encounters and for drinking alcohol often co-exist in both social dynamics and physical locations [7-10]. This means that the impact of alcohol
Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme
Veloshnee Govender,Matthew F. Chersich,Bronwyn Harris,Olufunke Alaba
Global Health Action , 2013, DOI: 10.3402/gha.v6i0.19253
Abstract: Background: In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. Objectives: This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Methods: Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Results: Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Conclusion: Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.
Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services
Matthew F Chersich,Stanley Luchters,Innocent Ntaganira,Antonio Gerbase
Journal of the International AIDS Society , 2013, DOI: 10.7448/ias.16.1.17980
Abstract: Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results: We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions: There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for sex workers, using current CD4 thresholds, or possibly earlier for prevention. Services implemented at sufficient scale and intensity also serve as a platform for subsequent community mobilization and sex worker empowerment, and alleviate a major source of incident infection sustaining even generalized HIV epidemics. Ultimately, structural and legal changes that align public health and human rights are needed to ensure that sex workers on the continent are adequately protected from HIV.
Sex work and the 2010 FIFA World Cup: time for public health imperatives to prevail
Marlise L Richter, Matthew F Chersich, Fiona Scorgie, Stanley Luchters, Marleen Temmerman, Richard Steen
Globalization and Health , 2010, DOI: 10.1186/1744-8603-6-1
Abstract: Drawing on existing literature, the authors highlight the increased vulnerability of sex workers in the context of the HIV pandemic in southern Africa. They argue that laws that criminalise sex work not only compound sex workers' individual risk for HIV, but also compromise broader public health goals. International sporting events are thought to increase demand for paid sex and, particularly in countries with hyper-endemic HIV such as South Africa, likely to foster increased HIV transmission through unprotected sex.The 2010 FIFA World Cup presents a strategic opportunity for South Africa to respond to the challenges that the sex industry poses in a strategic and rights-based manner. Public health goals and growing evidence on HIV prevention suggest that sex work is best approached in a context where it is decriminalised and where sex workers are empowered. In short, the authors argue for a moratorium on the enforcement of laws that persecute and victimise sex workers during the World Cup period.Although a subject not usually broached by mainstream media or politicians, sex work has recently received increased attention in southern Africa. A Swaziland senator sparked public debate by suggesting sex work be legalised [1]. In Malawi, human rights non-governmental organisations (NGOs) are taking up a case against the police after they arrested 14 sex workers, forcibly tested them for HIV and reported their HIV results in the media [2]. The women were fined 1000 Malawian Kwatcha for trading in sex while having a sexually transmitted infection (STI). In the build-up to the FIFA 2010 World Cup in South Africa, alongside concerns about crime and the coaching of the South African football team, there has been consternation over an anticipated increase in demand for paid sex during the tournament [3,4]. Some have called for the temporary legalisation of sex work, while others have advocated a forceful crackdown on sex workers, involving mandatory HIV testing and sex worker r
Use of AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and sexual behaviour in male sex workers in Kenya
Stanley Luchters, Scott Geibel, Masila Syengo, Daniel Lango, Nzioki King'ola, Marleen Temmerman, Matthew F Chersich
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-384
Abstract: A cross-sectional survey in 2008 recruited male sex workers who sell sex to men from 65 venues in Mombasa district, Kenya, similar to a 2006 survey. Information was collected on socio-demographics, substance use, sexual behaviour, violence and STI symptoms. Multivariate models examined associations between the three measures of alcohol use and condom use, sexual violence, and penile or anal discharge.The 442 participants reported a median 2 clients/week (IQR = 1-3), with half using condoms consistently in the last 30 days. Of the approximately 70% of men who drink alcohol, half (50.5%) drink two or more times a week. Binge drinking was common (38.9%). As defined by AUDIT, 35% of participants who drink had hazardous drinking, 15% harmful drinking and 21% alcohol dependence. Compared with abstinence, alcohol dependence was associated with inconsistent condom use (AOR = 2.5, 95%CI = 1.3-4.6), penile or anal discharge (AOR = 1.9, 95%CI = 1.0-3.8), and two-fold higher odds of sexual violence (AOR = 2.0, 95%CI = 0.9-4.9). Frequent drinking was associated with inconsistent condom use (AOR = 1.8, 95%CI = 1.1-3.0) and partner number, while binge drinking was only linked with inconsistent condom use (AOR = 1.6, 95%CI = 1.0-2.5).Male sex workers have high levels of hazardous and harmful drinking, and require alcohol-reduction interventions. Compared with indicators of drinking frequency or pattern, the AUDIT measure has stronger associations with inconsistent condom use, STI symptoms and sexual violence. Increased use of the AUDIT tool in future studies may assist in delineating with greater precision the explanatory mechanisms which link alcohol use, drinking contexts, sexual behaviours and HIV transmission.Globally, researchers and policy makers are increasingly giving attention to the effects of alcohol use on sexual behaviour; with many making a strong case that heavy alcohol use is an important cause of unsafe sexual behaviour and consequent HIV transmission in sub-Sahara
Maternal morbidity in the first year after childbirth in Mombasa Kenya; a needs assessment
Matthew F Chersich, Nicole Kley, Stanley MF Luchters, Carol Njeru, Elodie Yard, Mary J Othigo, Marleen Temmerman
BMC Pregnancy and Childbirth , 2009, DOI: 10.1186/1471-2393-9-51
Abstract: This needs assessment entailed a cross-sectional survey with 500 women attending a child-health clinic at the provincial hospital in Mombasa, Kenya. A structured questionnaire, clinical examination, and collection of blood, urine, cervical swabs and Pap smear were done. Women's health care needs were compared between the early (four weeks to two months after childbirth), middle (two to six months) and late periods (six to twelve months) since childbirth.More than one third of women had an unmet need for contraception (39%, 187/475). Compared with other time intervals, women in the late period had more general health symptoms such as abdominal pain, fever and depression, but fewer urinary or breast problems. Over 50% of women in each period had anaemia (Hb <11 g/l; 265/489), with even higher levels of anaemia in those who had a caesarean section or had not received iron supplementation during pregnancy. Bacterial vaginosis was present in 32% (141/447) of women, while 1% (5/495) had syphilis, 8% (35/454) Trichomonas vaginalis and 11% (54/496) HIV infection.Throughout the first year after childbirth, women had high levels of morbidity. Interface with health workers at child health clinics should be used for treatment of anaemia, screening and treatment of reproductive tract infections, and provision of family planning counselling and contraception. Providing these services during visits to child health clinics, which have high coverage both early and late in the year after childbirth, could make an important contribution towards improving women's health.In recent years, maternal health services in resource-constrained settings have increasingly focused on the importance of skilled birth attendants and the management of intrapartum complications [1]. Also, much efforts have been made to rationalise the package of services for antenatal care [2,3]. Antenatal care coverage remains high in most of Africa and the proportion of births which occur within medical services is s
The Contribution of Emotional Partners to Sexual Risk Taking and Violence among Female Sex Workers in Mombasa, Kenya: A Cohort Study
Stanley Luchters, Marlise L. Richter, Wilkister Bosire, Gill Nelson, Nzioki Kingola, Xu-Dong Zhang, Marleen Temmerman, Matthew F. Chersich
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068855
Abstract: Objectives To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described. Design Cohort study with quarterly follow-up visit over 12-months. Methods Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing. Results Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use. Conclusions High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
Efavirenz use during pregnancy and for women of child-bearing potential
Matthew F Chersich, Michael F Urban, Francois WD Venter, Tina Wessels, Amanda Krause, Glenda E Gray, Stanley Luchters, Dennis L Viljoen
AIDS Research and Therapy , 2006, DOI: 10.1186/1742-6405-3-11
Abstract: Concerns of efavirenz-induced fetal effects stem from animal studies, although the predictive value of animal data for humans is unknown. Four retrospective cases of central nervous system birth defects in infants with first trimester exposure to efavirenz have been interpreted as being consistent with animal data. In a prospective pregnancy registry, which is subject to fewer potential biases, no increase was detected in overall risk of birth defects following exposure to efavirenz in the first-trimester.For women planning a pregnancy or not using contraception, efavirenz should be avoided if alternatives are available. According to WHO guidelines for resource-constrained settings, benefits of efavirenz are likely to outweigh risks for women using contraception. Women who become pregnant while receiving efavirenz often consider drug substitution or temporarily suspending treatment. Both options have substantial risks for maternal and fetal health which, we argue, appear unjustified after the critical period of organogenesis (3–8 weeks post-conception). Efavirenz-based triple regimens, initiated after the first trimester of pregnancy and discontinued after childbirth, are potentially an important alternative for reducing mother-to-child transmission in pregnant women who do not yet require antiretroviral treatment.Current recommendations for care for women who become pregnant while receiving efavirenz may need to be re-considered, particularly in settings with limited alternative drugs and laboratory monitoring. With current data limitations, additional adequately powered prospective studies are needed.An increasing number of women worldwide are benefiting from expanding access to antiretroviral treatment, allaying initial concerns that women would have inequitable access to treatment. In sub-Saharan Africa nearly six out of ten adults receiving antiretroviral (ARV) treatment are women, an equitable distribution as more women are infected than men [1]. A substantial
Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya
Stanley Luchters, Matthew F Chersich, Agnes Rinyiru, Mary-Stella Barasa, Nzioki King'ola, Kishorchandra Mandaliya, Wilkister Bosire, Sam Wambugu, Peter Mwarogo, Marleen Temmerman
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-143
Abstract: A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P < 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P < 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7–6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1–6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending ≥ 4 peer-education sessions, compared with 34% (25/73) in those attending 1–3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P = 0.36).Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.Despite 25 years of HIV prevention, in many settings HIV incidence remains high in the general population and especially among most-at-risk groups [1]. In particular, women in sub-Saharan Africa remain disproportionately affected by HIV, which reflects and reinforces underlying gender inequities. Female sex workers (FSW), estimated to number tens of millions worldwide [2], are highly vulnerable to acquiring and transmitting sexually-transmitted infections (STI) including HIV [3]. Targeting most-at-risk groups such as FSW is a key strategy for p
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